What Causes Hepatocellular Carcinoma?

Doctors don't know the exact cause of hepatocellular carcinoma. Children who have
viral infections or other conditions that cause liver inflammation (swelling and irritation),
like viral hepatitis, get HCC more often
than other children.

Other less common causes or triggers include:

hereditary tyrosinemia (when a protein called tyrosine builds up in the body)

hereditary hemochromatosis (when excess iron is stored in the liver)

Wilson disease

progressive hepatic cholestasis (when the flow of bile from the liver is reduced)

How Is Hepatocellular Carcinoma Diagnosed?

When a child has hepatocellular carcinoma, the doctor will do an exam. Tests done
may include:

blood tests, including liver and kidney
function tests and an alpha fetoprotein (AFP) test (liver damage and some cancers
can raise the level of this protein in the blood)

How Is Hepatocellular Carcinoma Treated?

Doctors usually treat hepatocellular carcinoma with a combination of surgery and
chemotherapy. If possible, children with
cancer should go to a medical center specializing in the treatment of pediatric cancers.

Treatment depends on:

the child's age

the size of the tumor

whether there is one or many tumors in the liver

whether the cancer has spread from the liver

Treatment Options

Surgery is the most important part of treatment, but many HCC
tumors cannot be removed easily. A liver
transplant may be considered because the whole liver needs to be removed to get
the entire tumor out.

Chemotherapy is often used but is not very effective in shrinking
HCC.

Radioembolization (or Y90) is a type of therapy that delivers
high-dose radiation directly to the liver tumor through the bloodstream. The radiologist
inserts a tiny catheter (plastic tube) in the groin and passes it to the artery closest
to the tumor. This procedure protects much of the normal liver tissue from the effects
of Y90.

Y90 can be used as primary therapy in liver tumors that don't respond well to chemotherapy.
It's also used when the tumors come back or don't shrink enough for surgery.

Transarterial radioembolization (TARE), which delivers a high
dose of radiation therapy directly into the tumor(s).

Looking Ahead

Hepatocellular carcinoma is challenging to treat, even before it spreads beyond
the liver. Clinical trials are underway to help find better treatments in children
and adults.

After treatment, a child will have frequent checkups with the care team especially
because there is a possibility that the cancer may return.

Having a child being treated for cancer can feel overwhelming for any family. But
you're not alone. To find support, talk to your child's doctor or a hospital social
worker. Many resources are available to help you get through this difficult time.